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Hospital Emergency Operations Plan Workshop
Updating the Hospital and Rural Medical Center EOP for the Use of Volunteers in Medical Surge
By Mr.Mahboob ali khan MHA CPHQ USA
Acknowledgements:• This workshop was developed by the Mesa County Health
Department as part of the National Association of City and County Health Officials (NACCHO) Advanced Practice Centers (APC) Program (Blueprint Project.)
• It takes into account new information in light of: – Emergency Support Function 8 (ESF8) Planning;– Homeland Security Exercise and Evaluation Program (HSEEP); – Hospital Incident Command System (HICS); and– National Health Security Strategy (NHSS).
• California Emergency Medical Services Authority’s Clinic Emergency Preparedness Project is acknowledged for providing a framework from which a Hospital Emergency Operations Plan template could be created.
• Contributions of Family Health West Hospital, Fruita, Colorado in the review and revision of this information.
Objectives
• Participants will understand the importance and process needed for All Hazard emergency operations planning in Hospitals.
• Participants will understand the phases of Emergency Management.
• Participants will understand how an incident command leadership structure is an integrated component of the Hospital emergency operations planning .
• Participants will understand the major components needed to write an effective hospital emergency operations plan.
• Participants will understand why volunteer use in medical surge is critical to writing an effective plan for rural hospitals.
Why is this an issue today?
• Terrorism• Disasters• Other
– What keeps you awake at night?
– What often happens?
– What are you unprepared for?
– What can be done to plan for these situations?
FEMA News – Andrea Booher
I knew this would
happen!
How does terrorism/disasters affect the healthcare system?
• Produces mass casualties– Murrah Building in
Oklahoma City– Suicide bombers in
Middle East– Olympic Park Bombing
in Atlanta– Twin Towers in New York– Hurricane Katrina– Virginia Tech School
Shooting– Mexican Hat, Utah Bus
rollover
(AP-Associated Press)
How does terrorism/disasters affect the healthcare system?
• Produces a redirection of resources and change in preparedness activities– Smallpox planning for
hospitals and health departments
– H1N1 Strategic National Stockpile (SNS) – vaccines and drug caches, mass dispensing plans
– Surge capacity planning– Agro-chemical/oil and gas
chemical regulatory compliance issues
Haven’t we done this before?
• Pre-1950’s “Civil Defense” Era. • “Fire Protection” Era (1960’s-1970’s)• “Disaster” Planning Era (1970’s)• Emergency response for hospitals used to mean
a disaster plan, fire plan, utility failure plan.• Current (post- 9-11) all-hazards expectations
(public/partners): community integration, address all aspects of patient care issues, records and data tracking/security, supply status tracking, surge resource tracking.
• Result: more complex planning due to a more complex response.
Hospital planning & preparedness
• County Mass Casualty Plan• Surge capacity planning (H1N1)• Aligns with EOP plans at
city/county level• NIMS/ICS compliance • Homeland Security compliance
funding• HPP deliverables • LPHA grants and deliverables
Hospital planning & preparedness
• State Hospital Associations: Emergency planning, HSEEP , state-level hospital coordination systems.
• “9-11” and heightened expectations for increased integration in surge capacity and response.
• Tendency towards credentialing and accreditation:– Credentialing for surge staff/volunteers– National trends toward accreditation: schools and health
departments. – What will be the future relationship between CMS-CoP’s and
Joint Commission Standards?
Chemical incidents – planning considerations
• What measures must be planned in advance to safely evacuate/ treat patients contaminated with toxic chemicals?
• Does your hospital have the capability to decontaminate?• What antidote medications might be important if a chemical
terrorist attack occurred?
Definitions
• Capacity: amount or availability of resources and ability of staff, training, and depth.
• Capability: type of services in terms of emergencies, partnerships, and readiness.
• Vulnerability: susceptibility to failure due to inadequate resources, training, equipment, or planning. The goal is to decrease vulnerability.
• Readiness/Preparedness: a direct result of the adequacy of planning and the potential of those plans to create results in the area of training and resources.
What is an incident?• Any event that overwhelms
existing resources to deal with that event.– Weather – tornadoes,
flooding, severe storms– Terrorism– Infrastructure failures
affecting operations for a prolonged period
– Hazardous materials incident
– Large volume of patients– Pandemic
Incident implications
• Transportation• Electrical• Telephone • Water• Fuel• Structural• Communications
Incident implications
• Incidents restrict and overwhelm resources, communications, transportation and utilities.
• Individuals and communities are cut off from the outside support.
What is your goal in an incident?
• RESPONSE – manage victims (treat, triage, transfer, disposition).
• RECOVERY – operational, financial, and return to “normal” operations.
All Hazards approach to planning
• A conceptual framework for organizing and managing emergency protection efforts.
Who is involved in All Hazard response efforts?
• Federal• Tribal• State• Local• Emergency
Management• Public Works• Fire/Rescue• EMS• Hospitals• Public Health
All Hazard steps• Planning• Training• Exercising• Policies &
procedures• Resource
requirements• Resource upgrade
Major Incident Operations
• Disruption of normal process of health care delivery
• Displacement of day-to-day patient management of casualties
• Distraction of health care providers from usual workflow
• Addition of mental health burden
• Disruption of supply chain
• Disruption of communication systems
• Fiscal disruption
Emergency Operations Plan
• Introduction• Procedures &
Operations• HICS Job Action
Sheets• Specific
Departmental Tools
• Forms/Resources
Emergency Operations Plan-Part 1
• Introduction– General overview of <Hospital Name> and
facilities/support.
• Purpose/Policy– Provide continuous quality improvement.– Provide coordination and integration.
• Scope– Addresses Joint Commission and CMS
Conditions of Participation (CoPs.)
All Hazards Emergency Operations
• Mitigation:– Removing/lessening the conditions that lead to
incidents.
• Preparedness– Readiness for the unavoidable.
• Response – Decreasing the severity/intensity of an incident.
• Recovery– Getting back to normal.
Mitigation
• Hospital Hazard Vulnerability Analysis (HVA)
• Multiple Tools Available
Mitigation
• Hazard identification
• Hazard Assessment (HVA)
• Structural code compliance
• Equipment and maintenance
Preparedness• Plan development
• Training courses
• Exercises
• Employee education and competencies
• Public education
Response• Alerting• Assessment• Mobilizing- Healthcare
partners and ESF8• Implementing plan• Activate systems
(HICS, EOC)• Control, Set priorities-
Infection etc.• Communication and
situational awareness
Recovery
• Those activities undertaken by a hospital after an emergency or disaster occurs to restore minimum services and move towards long-term restoration.
Recovery
• Return to “normal”• Detailed damage
assessment• Care and shelter
continues• Funding
assistance• Remove debris
Part 2- Specific procedures & operations
• Patient Flow– Triage– Treatment Areas
• Security Activities– Entry & Egress– Visitors Access
Procedures & operations
• Communications– Telephone– Back-up systems– Radio (VHF/800)– Satellite phone– Walkie – Talkies– HAM radio– Fax
Procedures & operations
• Patient admissions, triage, disaster tags, registration process– Elective
procedures– Discharge of
patients
Procedures & operations
• News Media– Public
Information Officer (PIO)
– Strategic location
– Joint Information Center (JIC)
Procedures & operations
• Hotline
• Family of victims, visitors, outpatients
Procedures & operations
• Supplies & equipment– Essential supplies– Pharmaceuticals– Medical supplies– Equipment– Food– Water– Linen– Utilities
Procedures & operations
• Morgue– DOAs
– Others that expire
Procedures & operations
• Evacuation– Authority– Transportation– Location– Evacuation
routes– Practice/Test
Procedures & operations
• Continuing and/or reestablishing operations
• Off – site care (Alternate Care Sites, or ACS)
Procedures & operations
• Essential utility alternatives– Electrical– Water– Medical gas– Waste
disposal– Fuel
Procedures & operations
• Isolation & decontamination– Plan &
procedure– Equipment– Training
Procedures & operations
• Orientation & education
• Annual plan evaluation
Emergency Operations PlanPart 3- HICS Job Action
Sheets
HICS Job Action sheets
• Incident Command
• Operations
• Logistics
• Finance and Administration
• Planning
• Others
HICS Job Action sheets
• One for each position.
• Embodies title, mission/function and duties.
• Adjusted to meet hospital needs.
Emergency Operations PlanPart 4
Specific department tools
Specific departmental plans
• Emergency Department
• Security
• Maintenance
• Nursing floors
• Admission policy & registration
• Emergency triage
• Evacuation
• Communications
• Emergency Operations Center
Emergency Operations PlanPart 5-forms/resources
Forms/Resources• Help drive
positions• Documentation
aid• Financial
recovery• Decreases
liability• Enhances &
tracks communication
Emergency Management
A successful interface needs:•Planning•Training•Exercising
According to Joint Commission1:
• Emergency Management is now its own accreditation manual chapter.
• All Standards and Elements of Performance from 2009 are incorporated into the 2010 Emergency Management chapter.
• This new chapter contains some standards that were in HR, EC and MS sections.
• Critical Access Hospital requirements are similar to other types of hospitals in most counties.
1 http://www.jointcommission.org/
Emergency Operations Plan
Emergency Operations Plan (EOP) describes response procedures:– Written plan– Capabilities to self-sustain for up to 96 hours
[EM.02.01.01]– As well as
• Recovery strategies and surge capabilities.• Initiation and termination of response and recovery
phases.• Defines authorities and community relationships• Alternative care sites, alternate EOC.• Actual implementation is documented.
Emergency Operations Plan
• Plan Structure
Emergency Operations Plan
• Addresses Twelve Critical Access Hospital Joint Commission Components: – Planning [EM.01.01.01]– The EOP [EM.02.01.01]– Communication [EM.02.02.01]– Resources & Assets [EM.02.02.03]– Safety & Security [EM.02.02.05]– Staff responsibilities [EM.02.02.07]– Utilities Management [EM.02.02.09]– Patient, clinical & support activities [EM.02.02.11]– Volunteer Management [EM.02.02.13]– Volunteer Credentialing [EM.02.02.15]– HVA and Evaluation [EM.03.01.01]– Plan Evaluation [EM.03.01.03]
Emergency Operations Plan
• EM.01.01.01 Planning (8 measures)– The critical access hospital engages in planning activities prior
to developing its written Emergency Operations Plan.
• EM.02.01.01 The Plan (8 measures)– The critical access hospital has an Emergency Operations
Plan.
• EM.02.02.01 Communication (15 measures)– As part of its Emergency Operations Plan, the critical access
hospital prepares for how it will communicate during emergencies.
• EM.02.02.03 Resources & Assets (9 measures) – As part of its Emergency Operations Plan, the critical access
hospital prepares for how it will manage resources and assets during emergencies.
Emergency Operations Plan
• EM.02.02.05 Safety and Security (9 measures)– As part of its Emergency Operations Plan, the critical access
hospital prepares for how it will manage security and safety during an emergency.
• EM.02.02.07 Staff Responsibilities (9 measures)– As part of its Emergency Operations Plan, the critical access
hospital prepares for how it will manage staff during an emergency.
• EM.02.02.09 Utilities Management (7 measures)– As part of its Emergency Operations Plan, the critical access
hospital prepares for how it will manage utilities during an emergency.
• EM.02.02.11 Patient, clinical & support activities (8 measures)– As part of its Emergency Operations Plan, the critical access
hospital prepares for how it will manage patients during emergencies.
Emergency Operations Plan
• EM.02.02.13 Volunteer Management (9 measures)– During disasters, the critical access hospital may grant disaster
privileges to volunteer licensed independent practitioners.
• EM.02.02.15 Volunteer Credentialing (9 measures) – During disasters, the critical access hospital may assign disaster
responsibilities to volunteer practitioners who are not licensed independent practitioners, but who are required by law and regulation to have a license, certification, or registration.
• EM.03.01.01 Vulnerability Assessment and Evaluation (3 measures)– The critical access hospital evaluates the effectiveness of its
emergency management planning activities.
• EM.03.01.03 Evaluating the Plan (17 measures)– The critical access hospital evaluates the effectiveness of its
Emergency Operations Plan.
Use of volunteers in medical surge
• 18 Elements of Performance (EP’s) of Joint Commission Standards address use of volunteers.
• Medical Surge exercises that are HSEEP-compliant must address the use of volunteers in surge activities.
• How deep is your hospital in each staff skill area? By department? Supervisor? Facility? Occupation? Specialty?
For Volunteer Licensed Independent Practitioners and
Volunteer Practitioners
• Section 1: Disaster Privileges
• Section 2: Credentials Verification
• Section 3: Volunteer Oversight
• Section 4: Cessation of Volunteers
Use of volunteers
• What can they do?• What can’t they do, unless supervised?• What shouldn’t they do?• Who can they be?• Can spontaneous unassigned volunteers
(“SUVs”) be used?• What are the most likely scenarios?• Who can and cannot supervise volunteers?
Review: The Emergency Operations Plan
• Covers all of the All Hazards phases of Emergency Management– Mitigation
– Planning
– Response
– Recovery
• As well as communications with ESF8 partners
Where do I start?• <Hospital Name>
has:– Emergency
Operations Plan
(a base plan to start with).
– Departmental Plans (ED, Triage, Admissions, Evacuation, Security.
– Email <hospital point of contact> to receive the plans electronically.
Center for HICS Education & Training- www.hicscenter.org
• Guidebook• Training Resources• Job Action Sheets• Forms• Internal (13) & External
(14) Scenarios
<Presenter POC information>